Archived: Granton Medical Centre

Updated 10 January 2017

Granton Medical Centre is located in a residential area of Kings Norton, Birmingham. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and holds a General Medical Services (GMS) contract with NHS England. The GMS contract is a contract agreed nationally between general practices and NHS England for delivering primary care services to local communities. At the time of our inspection, Granton Medical Centre was providing medical care to approximately 8,100 patients.

The practice has a relatively high elderly population when compared with the local average. 21% of the patients are aged over 65 years and 10% are aged over 75 years (the local averages were 12% and 6%).

The practice is spread over three floors, with consulting rooms on the first two floors, and three separate waiting areas for patients. Staff wear name badges and there are name plates on all rooms. There is a self-check-in system, which means that patients do not have to queue at the reception desk to book in. Photographs of the clinical and administrative staff are displayed in the main reception area.

Car parking is available on site and on the road outside. Wheelchair access is available with staff assistance (patients ring the front doorbell and a staff member will guide them to the door with ramp access). There is a drop off point and car park spaces for disabled patients next to the surgery entrance.

There are two male GP partners, plus four salaried GPs (one male, three female). The GPs are supported by a practice manager, two practice nurses, two health care assistants and administrative and reception staff.

The practice offers a full range of family medical services and also provides enhanced services for patients. An enhanced service is separate from the core GMS contractual requirement and is commissioned to improve the range of services available to patients. Enhanced services offered by the practice include minor surgery, extended hours access, avoiding unplanned admissions and facilitating timely diagnosis and support for people with dementia. The practice undertakes some minor operations for patients from other practices under the terms of a Local Improvement Scheme, for example, carpal tunnel injections.

Granton Medical Centre is an approved training practice for trainee GPs and student doctors. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There are currently three GP trainees at the practice: one trainee GP and two foundation year two doctors.

The practice is also a teaching practice for medical students from the University of Birmingham. Medical students have not yet qualified as doctors. A total of eight students are accepted in two teaching blocks per year.

During the week the practice opens from 8.30am until 1pm and from 2pm until 6.30pm. The practice is closed at weekends. Patients can also attend the Walk-In Centre in Selly Oak, Birmingham, which is open from 8am to 8pm seven days a week.

Out of hours cover is provided by the NHS 111 service from 6.30pm until 8am. Calls are diverted to the practice mobile phone between 8am and 8.30am and between 1pm and 2pm.

Updated 10 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Granton Medical Centre on 12 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and clear approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff had the skills and expertise to deliver effective care and treatment to patients in line with current evidence based guidance.
• The practice participated in the Birmingham Cross City Clinical Commissioning Group’s (CCG) programmes, Aspiring to Clinical Excellence (ACE) at Foundation and ACE Excellence levels.
• The practice also participated in the CCG’s Quality Conferrals And Pathway Scheme (QCAPS), which aimed to improve referral management and decrease unnecessary referrals by conferral with other GPs in the scheme.
• Patients said that they were treated with compassion, dignity and respect. They told us that clinical staff ensured that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had assessed 50% of patients aged over 75 years with respect to risk of falls. This had been achieved by opportunistic screening during appointments and at the annual flu clinics.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients and from the Patient Participation Group (PPG). For example, a privacy screen was fitted to the reception desk as a result of a PPG recommendation.
• The weekly Nordic Walking Group, funded by Birmingham City Council, evolved from a PPG open day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice had been commissioned by the Clinical Commissioning Group (CCG) to become an Any Qualified Provider (AQP) for anticoagulation services (anticoagulants are medicines which are prescribed to help prevent blood clots). Referrals were accepted from neighbouring practices and domiciliary visits were offered to housebound patients.
• Two members of the PPG had trained to become volunteer bereavement counsellors. Sessions were held twice a week at the practice.

The areas where the provider should make improvement are:

• Consider drawing up guidelines for checking uncollected prescriptions before destruction.
• Risk assess the need to stock children’s pads for the defibrillator.
• Formalise arrangements for ensuring that patient safety alerts are viewed by all clinicians after periods of absence or annual leave.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 January 2017

The practice is rated as good for the care of people with long-term conditions.

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had been commissioned by the Clinical Commissioning Group (CCG) to be an Any Qualified Provider (AQP) for anticoagulation services (anticoagulants are medicines which are prescribed to help prevent blood clots). Referrals were accepted from neighbouring practices and domiciliary visits were offered to housebound patients.
• The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 86%, which was 9% above the CCG average and 8% above the national average.
• The practice scored maximum points in the Quality and Outcomes Framework (QOF) 2014/15 for long term conditions such as chronic kidney disease and chronic lung disease.
• The practice took part in the CCG’s Aspiring to Clinical Excellence Foundation and ACE Excellence programmes. This ensured that high standards of chronic disease management were met in excess of the standards laid down in the core General Medical Services contract and the Quality and Outcomes Framework (QOF).
• Longer appointments and home visits were available when needed for patients with long term conditions.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Reception staff tried to book consecutive appointments with a nurse and GP appointments in order to avoid the patient attending twice for a review.
• There was a self-help page on the practice website which had links to video clips on the NHS Choices website. The website also had a Library section which had links to patient information leaflets to help patients manage their long term conditions. For example, there were leaflets about angina, asthma, diabetes and osteoarthritis.

Updated 10 January 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Children who did not attend secondary care appointments were flagged up to the data manager and to the buddy receptionist of the relevant GP. The buddy receptionist would contact the family in the first instance to find out the circumstances for the non-attendance.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The cervical screening uptake was 74%, which was higher than the clinical Commissioning Group (CCG) average of 66% and the same as the national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 10 January 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had been instrumental in setting up a Local Improvement Scheme (LIS) for Nursing Homes and Residential Homes in South Birmingham. A GP had been the chair of the Care Homes Group. The LIS had been a 12 month pilot scheme, which was changed to a Nursing Home LIS after the pilot ended.
• There was a nominated GP lead for each residential home where the practice had patients.
• We spoke with managers of four local homes who all spoke very highly of the service offered to their residents. The managers told us that the GPs were very caring and professional and that they valued the long standing relationship with the practice. We were told that the GPs would always take the time to listen to residents and explain treatment options to them and to their next of kin.
• Older patients identified through the Unplanned Admissions enhanced service were discussed at weekly practice meetings to ensure that they were receiving suitable community support for their needs.
• The practice had proactively assessed 50% of patients aged over 75 years with respect to falls risks. This had been achieved by opportunistic screening during appointments and at the annual flu clinics.
• The practice followed the Gold Standard Framework principles and held meetings every two months with the palliative care nursing team.
• Alzheimer’s UK had delivered a presentation to non-clinical staff at a protected time learning session in order to raise awareness of signs of potential dementia.
• Alzheimer’s UK ran a drop-in service at the practice every month. Patients with all forms of dementia and their carers could access general advice in the reception area or be seen by a trained worker to get personalised advice and be signposted to other services.
• A selection of NHS information videos could be downloaded from the practice website including the importance of staying active over the age of 60 and foot care for older people.

Updated 10 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Patients could book routine GP appointments online at a time that was convenient to them as well as request repeat prescriptions.
• Patients could sign up to receive text messages for appointment reminders and health care.
• Extended hours phone appointments were available throughout the week, which provided flexibility for patients who could not attend the practice during opening hours.
• NHS Health Checks were offered by the nursing team.
• Flu clinics were scheduled on Saturday mornings, which provided flexibility for patients who could not attend during the week.

Updated 10 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 8% higher than the Clinical Commissioning Group (CCG) average and 11% above the national average.
• 91% of patients with poor mental health had a comprehensive care plan documented in the last 12 months, which was the same as the CCG average and 3% above the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice offered a range of enhanced services, for example, facilitating timely diagnosis and support for patients with dementia.
• The practice carried out advance care planning for patients with dementia.
• Non-clinical staff had received Dementia Friendly training.
• There was a monthly drop-in dementia clinic at the practice run by Alzheimer’s UK where patients and their relatives could go to obtain information about support services available.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had a higher than usual number of patients with gender dysphoria. We saw that this issue was dealt with in a sensitive manner.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Two members of the PPG had trained to become volunteer bereavement counsellors. Sessions were held twice a week at the practice.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice was involved in an Aspiring to Clinical Excellence (ACE) plus pilot scheme with West Midlands Ambulance Service to facilitate the GP review of 999 requests by vulnerable patients, who might not have a clinical need to be transported to hospital by emergency ambulance.
• The practice had a designated safeguarding lead.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The data manager co-ordinated the safeguarding registers, coding and meetings with the health visitor.